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Coordinated member care

Helping members understand how their network, plan medical group and primary care physician work together.

Sharp Health Plan has one team that works together to provide the best health care possible for our members. Below is a quick guide to help members better understand how these three important areas work together to ensure the coordination of their care.

A member's care is coordinated through a physician group called a plan medical group, or PMG.

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Our members receive primary care, specialty physician care and access to hospitals and other facilities through several physician groups called plan medical groups (or PMGs). These physician groups or PMGs are comprised of doctors, specialists and other providers who are located throughout San Diego and southern Riverside counties. We have ten plan medical groups:

  • Sharp Community Medical Group
  • Sharp Rees-Stealy Medical Group
  • SCMG Palomar Health Medical Group
  • SCMG Graybill North Coastal
  • SCMG Palomar Health Medical Group Temecula
  • SCMG Inland North Medical Group
  • Rady Children’s Health Network/CPMG
  • Greater Tri-Cities IPA
  • Optum Care-North County SD (formerly Primary Care Associates Medical Group)
  • Independent Providers Network

 

Plan medical groups are affiliated with plan networks.

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We have two individual and family plan networks — Premier and Performance.

We have four employer group plan networks — Premier, Performance, Value and Choice.

These networks cover specific geographic areas across San Diego and southern Riverside Counties. Members receive covered benefits and services from physicians who are affiliated with their plan medical group (PMG) and who are part of their plan network.

Tip: Members choose a network when they sign up for benefits each year. Once they’ve made their selection, they cannot make changes until the next open enrollment, unless they qualify for a special enrollment mid-year.

 

Primary care physicians are affiliated with both a plan medical group and a plan network.

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Members can find out which doctors are affiliated with a certain plan medical group (PMG) and network by using our online provider network directory.

Tip: Members can change their primary care physician at any time. If a member chooses a primary care physician in a different plan medical group — for example, they are switching from a doctor in Sharp Rees-Stealy to a doctor in the Sharp Community Medical Group — their current referrals or prior authorizations for specialists, special supplies or equipment will be voided. They must ask their new primary care physician for new referrals or prior authorizations.

 

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